The Pharmaceutical Journal
Vol 279 No 7481 p652
8 December 2007

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Why the future of pharmacy does not lie with the “responsible” pharmacist

By Steven Curtis

In reply to Tony Schofield’s fascinating postulation on the potential future of a “responsible” pharmacist (PJ, 10 November 2007, p527), I would like to offer one or two pragmatic thoughts and ideas of my own.

First, as a general observation, I would say pharmacists respond excellently when absolutely required to do so (such as instigating patient medication record systems and computerised labelling systems, introducing staff training and installing consultation areas, and so on), but I believe we are awful at instigating those “improvements” that are not classed as essential (such as all those above until one minute before they are absolutely required).

In this respect I envisage the new breed of “responsible” pharmacist to be no more effective, illuminating, career changing or useful to the public than any other ill-thought-out piece of legislative nonsense. A multiple will be required to list branch-specific “responsible” pharmacists and a list will be given. End of story. Effect nil.

Secondly, I believe the associated cornerstone of Mr Schofield’s article is to allow a responsible pharmacist to change his or her working practice to the benefit of the customer, without detriment to another customer — by allowing a non-pharmacist to fill the gap in time, space, role or conversation.

Herein lies the core of the problem: a day is only so long and a man or woman can only do so much. If time does not allow a pharmacist personally to oversee the dispensing of 400 prescriptions items, check 20 staff-filled monitored dosage system trays, perform 25 medicines use reviews, give out 20 lots of methadone, supply a couple of emergency hormonal contraceptives, give half a dozen smoking cessation consultations, handle 24 patient queries, make 36 calls for repeat prescriptions to be collected or delivered, have two coffee-breaks, eat one quick sandwich, carry out a staff appraisal, hold an interview, give The Pharmaceutical Journal a quick read, then the delegation of an unspecified amount of this workload to well-trained, cheaper, eager and knowledgeable staff may allow the overworked, overstressed and, frankly, overloaded pharmacist to reallocate his or her workload. But they would still be doing too much.

Let me fantasise a new regulation — that every pharmacy that dispenses 10,000 items or more in any one month would be required, by law, to have two pharmacists working.

Now, although the new regulation would mean the workload was divided nicely, and it seems a sensible workload to require two pharmacists to share, I can easily imagine the financial stress this would put single-shop independents under, how much it would reduce the profitability of share-driven limited companies and how hard it would ultimately be to apply because there simply are not enough pharmacists to fill the required positions.

And, using exactly the same argument, and with respect to Mr Schofield’s warm and cosy aspirations for a work-load shift onto the shoulders of other team members, all it does is delay the inevitable, ie, when the workload increases again to the point where a single pharmacist cannot cope with the inevitable increase in demands on his or her time.

This will happen as primary care trusts finally instigate local enhanced services, when pharmacies start to bid for contracts for screenings, diagnostic testing, clinics and patient group directions and assist their local surgeries in gaining quality outcomes framework points until, finally, pharmacists get given a prescription pad of their own and decide they have simply had enough of this malarkey and are going to get a proper job, like being a plumber.

Delegation is a time-delay bomb. It is an answer but it is not the answer. Putting a second pharmacist in every large pharmacy is also an answer but, for many reasons, also not currently the answer.

Finally, before I explain my situation, I would like to add a comment on the illogical and unviable use of the term “responsible pharmacist” in an environment where most pharmacies are manager-run and multiple-owned. The term “responsible” cannot, will not and should not be mistaken for “controlling”.

To imagine locum or relief pharmacists spending their first hour or so in a new pharmacy catching up with the shop-specific standard operating procedures, signing them and maybe amending them where necessary, as if they had any actual power to instigate changes before opening time, is ludicrous.

A branch of a multiple missing an SOP on how to supply methadone to addicts can be resolved quickly. A refrigerator that runs outside the required temperature range cannot be mended so quickly, but could be brought to the attention of the head-office and noted in a diary.

But if there were insufficient staff, if the Controlled Drug register’s running total did not match stock levels, if the computer was not linked to the hub or the consultation room not built, what power of responsibility does a walk-in locum actually have? It is a misnomer, and an unfair one at that.

And so to my solution. Pharmacy is not only growing in size but it is growing in colour. It is branching out, quickly, and in many different directions all at once. It really is an exciting time to be in the business but we are getting to a point where we do not know how to cope with our own success.

Delegation will allow us to focus our responsibilities where they are more specifically required, but it is a temporary measure because our successful growth rate will continue. We have done exceedingly well for a long time with a simple supply-defined income, but now we are moving towards an array of clinical or cognitive income streams that are more time-consuming.

However, a disposal of the supply function is not the answer but an error of biblical proportions for our profession in the long run.

We need to increase the number of pharmacists to fill the ever-increasing supply demand and to take on all the exciting new services, contracts and roles that are becoming part of our workload.

Yes, this has its own risks. There is a chance that supply one day will overtake demand and pharmacy risks being a profession that does not provide a guaranteed income for life. It could mean that we find our income changes if we are not negotiating our professional status correctly.

And, yes, it could mean that the future face of pharmacy shifts gradually away from its current shop-based operation to sit inside the grey-matter of a mobile pharmacist, taking his or her skills wherever they may be needed for whatever function they might be required.

But — and this is the big but — that scenario offers genuine responsibility, a genuine future for our profession and genuine benefit for the patients, too.